A systematic review of delays in seeking medical\ud attention after transient ischaemic attack

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Sprigg, Nikola ; Machili, C. ; Otter, M.E. ; Wilson, A. ; Robinson, T.G. (2009)

Abstract Background: Prompt assessment, investigation and early initiation of secondary prevention after TIA are effective in reducing recurrent stroke. Despite this many patients are slow to seek medical advice. Objective: We performed a systematic review to examine potential factors associated with delay in seeking medical review after TIA. Design: Systematic review. Data-sources: Electronic databases MEDLINE, EMBASE, and Science Citation Index (December 1995 - September 2008). Review methods: Electronic searches were performed for observational studies assessing patient delay in presentation after TIA. Results: Electronic search yielded 9 studies with data on presentation delay in TIA patients; variations existed in study size, population and methodology. A single study included TIA patients only (n=241), whilst the remaining 8 studies recruited both stroke and TIA patients, with TIA patients (n=821) making up only a small proportion of the total patient number (n=3,202). Length of delay varied greatly across all studies; in most studies TIA patients to attending emergency department arrived there within hours. Where patients first presented to their general practitioner 50% attended within 24 hours, whilst 25% waited 2 days or more, and recognition of symptoms as stroke/TIA did not reduce delay. Conclusions: The majority of delay in seeking assessment is due to a lack of response by the patient; many patients do not recognise stroke/TIA symptoms, and even when they do, many fail to seek emergency medical attention. The public needs educating to contact the emergency medical services or attend ED immediately after TIA. ns208@le.ac.uk (Sprigg, Nikola) cm242@le.ac.uk (Machili, Chipulwa) mleo1@leicester.ac.uk (Otter, Mary Edmunds) aw7@leicester.ac.uk (Wilson, Andrew) tgr2@le.ac.uk (Robinson, Thompson) University of Leicester - United Kingdom--> , DOSM,Clinical Sciences Buildin, Nottingham City Hospital--> , DOSM,Clinical Sciences Buildin, Nottingham City Hospital--> , Nottingham--> , NG5 1PB--> - UNITED KINGDOM (Sprigg, Nikola) University of Leicester - UNITED KINGDOM (Machili, Chipulwa) University of Leicester - UNITED KINGDOM (Otter, Mary Edmunds) University of Leicester - UNITED KINGDOM (Wilson, Andrew) University of Leicester - UNITED KINGDOM (Robinson, Thompson) UNITED KINGDOM Received: 2008-11-12 Revised: 2009-02-02 Accepted: 2009-02-25
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